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Gastaldo, Samantha
Digital Commons - Otterbein (Otterbein University). 2026 May 5.
This quality improvement project looks at the proposed implementation of endotracheal intubation guidelines regarding pregnant patients undergoing non-obstetric surgery and how the use of video laryngoscopy versus the traditional practice will affect the first pass rate of the endotracheal tube intraoperatively. Statistics show that 2% of women undergo non-obstetric related surgery during pregnancy. Physiological changes during pregnancy, including increased laryngeal mucosa swelling and higher metabolic oxygen consumption, result in a heightened risk of apnea and hypoxemia during intubation. Pregnant women experience an eightfold higher incidence of failed intubation compared to non-pregnant populations. The number of patients classified as Mallampati 4 increased by 34% from 12 to 38 weeks of gestation. In traditional practice, direct laryngoscopy with either a Macintosh blade or a Miller blade is a popular first-line intubation method. Video laryngoscope devices like the McGrath and Glidescope offer real-time airway visualization, improving intubation success rates by providing superior glottic views without requiring alignment of the oral, laryngeal, and pharyngeal axes. Despite video laryngoscopy showing higher first-pass success rates, its usage remains limited among anesthesia providers in obstetrics. Implementing video laryngoscopy as a standard for patients at 20 weeks of gestation could reduce maternal mortality. The proposed implementation will occur over one year at an urban level-one trauma facility. This quality improvement initiative aims to improve patient safety and minimize anesthesia-related mortality by promoting video laryngoscopy usage in at least 75 cases, ensuring sustainable integration into clinical practice
这个质量改进项目着眼于针对接受非产科手术的孕妇实施气管插管指南的提议，以及与传统做法相比，使用视频喉镜如何影响术中气管导管的首次插入成功率。统计数据显示，2%的女性在孕期接受与非产科相关的手术。孕期的生理变化，包括喉黏膜肿胀加剧和代谢性氧消耗增加，导致插管期间呼吸暂停和低氧血症的风险升高。与非孕妇群体相比，孕妇插管失败的发生率高出八倍。妊娠12至38周时，被归类为Mallampati 4级的患者数量增加了34%。在传统做法中，使用麦金托什喉镜叶片或米勒喉镜叶片进行直接喉镜检查是一种常用的一线插管方法。像麦克格拉斯喉镜和格莱德Scope喉镜这样的视频喉镜设备可提供实时气道可视化，通过提供出色的声门视野而无需口腔、喉部和咽部轴线对齐，从而提高插管成功率尽管视频喉镜显示首次插入成功率更高，但其在产科麻醉提供者中的使用仍然有限。将视频喉镜作为妊娠20周患者的标准做法可以降低孕产妇死亡率。提议的实施将在一家城市一级创伤机构进行一年时间。这项质量改进计划旨在通过在至少75例病例中推广视频喉镜的使用来提高患者安全性并将与麻醉相关的死亡率降至最低，确保可持续地融入临床实践。
